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HomeMy WebLinkAboutMiscellaneous - 316 CANDLESTICK ROAD 4/30/2018 (3) 316 CANDLESTICK ROAD 2101106.A-024&0000.0 4 t I I I I I. I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: M SIGNATURE: Building Commissionerfl for of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1/94 02ye Map Number P.aix"umber 1.3 Zoning Information: lA Property Dimensions: `j y Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHII'/AUTHORIZED AGENT 2.1 Owner of Record /-\r7 Na rmt) Address for Service QLgnaDk4 Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ A.10 Licensed Construction Supervisor: �� � O LlLicense Number ess �'1 / 9,7040 Expiration Date (J i Sign re Telephone 3.2 Registered Home Improvement Contractor Not P Applicable ❑ /Ian-IL7"/ Company Name IZ1106/ M Registration Number LM �/fly Ate � r.. q i�-off - "dre),42., 7-1b 6 fP 36 Expiration Date A� Sin re Telephone 0� e SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin rmit. Signed affidavit Attached Yes..... A No.......11 SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Completed by permit applicart 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, I" Jalo as Owner/Authorized Agent of subject property Hereby authorize �� ,�� to act on My behalf,in all matters relative to work authorized by this/building permit application. Si iaturg of Owner Date SECTION j7bb OWNER/AUTHORIZED AGENT DECLARATION I, !-✓/7/C. /l� �f,�� as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief rint e f Si at e of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all ne cessary a I Boards and Departments having jurisdiction have been obtained. This does no rs from elie the applicant and/or landowner from compliance with any applicable or requirements.Ve ** **** ********************APPLICANT FILLS OUT THIS SECTION APPLICANT D R�/J /��� PHONE_�S=_?® LOCATION: Assessor's Map Number PARCEL_,�Q�'y SUBDIVISION LOT(S) STREET_� ,� ,� ���(� _ ST. NUMBER OFFICIAL USE ECOMM D TIO OF TOWNAGENTS: CONS ATION A MINISTRATOR DATE APPROVLD DATE REJECTED_ COMMENTS Q� a c A TOWN NNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS a - I��s u Pzwi uv� C v✓�e..�— j" �L IF PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT , RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 jm 1 At P Fq NiF� t 4 .s 6 00 � �\ SE,Q t4 40 '�► � 1 1 x1710Vol I • � _ ✓lam -P ,a.� o�..//�aa��ua.,tla BOARD OF BUILDING REGULATIONS ' _ jLicense: CONSTRUCTION SUPERVISOR 066342 Birthdate 1-08/1514971 1'; f Expires 08/15%2003 Te.no: 3429 `iRestricted (�0 BARREN,MARTINO 44 ADDISON AVE METHUEN, MA 01844 Administrator" ` �rie'Vro�riiiriwiuiea/� ��iaCaoaac�iuoP '� `� Board of Building Regulations and Standards HOME IMPRbVEMENT CONTRACTOR Registration 124961 Expiration 09/17/2003 Type individual r 'i Darren Marino Darren Marino 44 ADDISON AVE. METHUEN,MA 01844 / L Administrator a -SANITARY TEE TEE ' i 1/2jw S E C T I 0 N 11NLET -20UTLET ( S ) BOX DISTRIBUTION BOX SDETw NOT TO 'SCALE REQUIF ON NK E NIF FREDERICK L. ROBERTS %X r�ot jqvol770 `) r�►s ` � OIV C.atAKAle �e INN F OF v / WET AV-CA SHALL IM L®T42 �O ' N'F �., '- 43 :N NEW LEACH TRENCH i �,� SYSTEM 1M!1 OQ'r. Sr 155,`-�• 3v �' . �- ���� FU7',tl`RE RESERVE qu /S6 q •f r►w ,C, $e / \ r 170 \ _ k ol was \ \ �� fig{ ?"s-:,rJ - .�►- _ __ -A \ \ y TE.Q SERVICE- 8 LOT 40 , ��,i► � --. , �. C_ D L E. w 9 r BENCHMARK: C.R . E�E:.• / / 1 \ �AS�A�tE r�ctu b Jb r" �JcE 1 7+ nMPENSATo \�'L WETL ANO AE r. r i r � r ._ � �-- - a �0 r [.. �, ✓fie TDoorvmaruuea�i a��/�.aaaacfzuaP,f a L; BOARD OF BUILDING REGULATIONS I License: CONSTRUCTION SUPERVISOR Number CS',. 066342 !! I-Birthdate X08/15%1971 Expires 08/15/2003 Tr.no: 3429 jF ' Rest ricteit:"M BARREN-MARTINO ; 44 ADDISON AVE EXT' METHUEN, MA 01844 Administrator 4 O"v ff" III lug Board of Building Regulations and Standards HOME IMF OVEMENT CONTRACTOR Re�Istratjon 124961 - +- Expiratioo pg/1.7/2003 (" at ttT�ipe individual Darren Marino -r c Darren Marino 44 ADDISON AVE. METHUEN,MA 01844 / � Administrator North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Locatio of Facility) Signa re of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I The Commonwealth of Massachusetts 1 Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 Workers'Compensation Insurance Affidavit :. . z. Please Print OEM SEEN= Name: Location,1�, A City /ll'F Phone- � � am a homeowner performing all work myself ram a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone# -Insurance-Co, Poll . i✓ompgry name: Address City: Phone# Insurance Co. Policy# Faiiure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal Penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($1 oo.oo)a day against re. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cert' der the pains and penalties of perjury that the information provided above is true and correct Signature g Date_ Print na Phone# f-•30� Official use only do not write in this area to be completed by city or town official' E] Building Dept C7Check if immediate response is required Building Dept p Licensing Board E] Selectman's Office Contact person: Phone#: Ej Health Department Other R,M WORKMAN'S COMPENSATION CAODL"i 1QC AZL-7( MOPOTED (bo m O.-J fWA)L i 2X to FLOOL MOJ—) 16 Int 61 Alk S 81e L AWt (�OW muj 0 ROUnID W DUP FWrmkS FT2ztj /���o' N2 3534 Date.................................. NOR7M °�<��`°;•1"° TOWN OF NORTH ANDOVER ? q.,f o # p PERMIT FOR WIRING ass^cHusE� This certifies that < .r ` f ... ............................... ......................................................... has permission to perform ��.... J� ' ...................... ..............:............................... wiring in the building of ` ' ' at 7 G r I , /f . ' �,'North Andover,.Mass./ ..... �j G Fee.. 1.....:........ Lic.No%�..��... .... ELECTRICALINSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of Massachusetts FOR OFFICE USE ONLY Department of Public Safety PemutNo. �ti V BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Receipt No. APPLICATIONFOR PERMIT TO- PERFORM ELECTRICAL WORK All work will be performed in accordance with the Massachusetts General Code.527 C 12:00/ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of ljo, A/L1 p U e-t- To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: l Location(Street and Number) _� b �--� 5-11`c-k g e Map: Lot: Owner or Tenant RLx4 h�G 1, 51,r.O i S Zone: Owner's Address �^-°- Is this permit in conjunction with as building permit? Yes❑ No©- u (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ;2 U 6 Amps Z Q / 2 Volts Overhead❑ Underground M--� No.of Meters New Service Amps / Volts Overhead ❑ Underground❑ No.of Meters Nul fiber of Feeders and Ampacity Location and Nature of Proposed Electrical WorkNo.of Lighting Outlets No.of Hot Tubs No.of Transformers . Total KVA _ No.of Lighting Fixtures Swimming Pool Above grnd.❑In-grnd.❑ Generators KVA No.of Receptacle Outlets No.of Oil Burners No.of Emerg:Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones No.iof Ranges No.of Air Cond. Total Tons No.of Detection and No.of Total Total Initiating Devices NOy of D1spOSd1S Heat Pumps Tons KW No.of Dishwashers Space/Area Heating KW No.of Sounding Devices No.of Self-Contained No.of Dryers Heating Devices KW Detection/Sounding Devices No.of Water Heaters KW No.of Signs No.of Ballasts Local❑ Muncioal Connection ❑ Other No.of Hydro Massage Tubs No.of Motors Total HP Low Voltage Wiring OTHER: INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES❑NO❑ I have submitted valid proof of same to this office.YES ❑NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE❑BOND❑OTHER❑ (Please Specify) (Expiration Date) .Estimated Value of Electric 1 Wgrk$ Work to Start ��/ Q ? Inspection Date Requested:Rough Final , /dd 0 Z Signed under the enalties of perjury: FIRM NAME ��a►-•vi T­vC4�2 LIC.NO. A�1) 9 I Licensee Signature LIC NO. C- s 70'Y Address /0 Aivt 4ctti _T-;V-V-. A-14 0192-3 Bus.Tel.No. 1700'7-f0 6`t as Alt.Tel.No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement. Owner❑ Agent❑ (Please check one) _.` _ Telephone No. PERMIT FEE$ -57, OC7 INSPECTION RECORD Date Notes — Remarks Inspector a nuasv io iaumo jo am}eu2►S)